Outcome of Colostomy

Closure and Influencing

Factors in patients with

Presentator
Pawan Chansaenroj MD.

Advisor
Piyawan Chiengkriwate MD.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
- Anorectalmalformation includes a
series of congenital lesions of the
hindgut and
urogenital organs.
- The reported incidence of anorectal
malformations range from 1: 3300 to
1 : 5000 live births.1
 
1 : Pena, A.Migotto-Krieger, M.Levitt, M. A., Colostomy in anorectal malformations:
a procedure with serious but preventable complications, J Pediatr Surg, 2006, 748-
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
- Recent years a growing number of
pediatric surgeons have begun
advocating the repair of anorectal
malformations in a primary fashion
without a colostomy.

- Most pediatric patients with an

anorectal malformation still receive a
protective colostomy before the main
repair to avoid contamination.
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
- Many surgeon pay attention and
often reveal the outcome and
complication of colostomy formation.
But….
- Just few studies have examined the
outcome and complications of
colostomy closure and the major
factors influencing the
2 : Chandramouli, outcome.
B.Srinivasan,
2,3
K.Jagdish, S.Ananthakrishnan,
Morbidity and mortality of colostomy and its closure in children,J Pediatr Surg, 2004,596-9
3 : Cigdem, M. K.,Onen, A.,Duran, H.,Ozturk, H.,Otcu, S.,
The mechanical complications of colostomy in infants and children: analysis of 473 cases of a
single center.
Pediatr Surg Int, 2006.22: 671-6
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
- Major complications include bleeding
, anastomosis leakage ,
intraabdominal abscess, abdominal
wall mucocele.2,3,6,10,11

2 : Chandramouli, B.Srinivasan, K.Jagdish, S.Ananthakrishnan,

Morbidity and mortality of colostomy and its closure in children,J Pediatr Surg, 2004,596-9
3 : Cigdem, M. K.,Onen, A.,Duran, H.,Ozturk, H.,Otcu, S.,
The mechanical complications of colostomy in infants and children: analysis of 473 cases of a single
center.
Pediatr Surg Int, 2006.22: 671-6 
6: Nour, S.Beck, J.Stringer, M. D., Colostomy complications in infants and children,
Ann R Coll Surg Engl, 1996, 78: 526-30 
10 : Memetoglu, M. E.Boleken, M. E.Baba, F.Kaya, M.Kanmaz, T.Yucesan, S.,
Abdominal wall mucocele: a late complication of colostomy closure, Int Wound J. 2008,5: 56-8
11 : Yajko, R. D.Norton, L. W.Bloemendal, L.Eiseman, B.,
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Backgroun
d
- Some factors have been found to be
prognostic or influencing the
colostomy closure results such as co-
morbidity before stroma closure, type
and location of colostomy.4,5,7,8,9
4 : Gardikis, S.Antypas, S.Mamoulakis, C.Demetriades, D.Dolatzas, T.Tsalkidis, A.Chatzimicael, A.Polychronidis,
A.Simopoulos, C.,
Colostomy type in anorectal malformations: 10-years experience, Minerva Pediatr, 2004,56: 425-9
5 : Ghorra, S. G.Rzeczycki, T. P.Natarajan, R.Pricolo, V. E.,
Colostomy closure: impact of preoperative risk factors on morbidity, Am Surg, 1999 ,65: 266-9
7 : Mosdell, D. M.Doberneck, R. C.,
Morbidity and mortality of ostomy closure, Am J Surg, 1991, 162: 633-6; discussion 636-7
8 : Demetriades, D.Pezikis, A.Melissas, J.Parekh, D.Pickles, G.,
Factors influencing the morbidity of colostomy closure, Am J Surg, 1988, 155: 594-6
9 : Wong, R. W.Rappaport, W. D.Witzke, D. B.Putnam, C. W.Hunter, G. C.,
Factors influencing the safety of colostomy closure in the elderly, J Surg Res, 1994,57: 289-92
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Research
question

What are outcome of colostomy

closure and influencing factors in
patients with anorectal
malformation ?
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design :
Title
Title :
Outcome of Colostomy Closure and
Influencing
Factors in patients with Anorectal
Malformation.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Primary outcome
- First feeding time , Length hospital stay ,
Complication rate

Secondary outcome
- Relationship about suspected influencing
factor* and outcome
* : ( 1.Adhesion 2. Quality of bowel preparation 3.Intra-operative Fecal contamination
4. Co- Morbidity prior surgery 5.Ganglion cell number 6.Colostomy type )
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Design
- A retrospective descriptive – analytic
study
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Patient
- All patients with anorectal
malformation who were admitted
between January 1997 and
December 2007 and receive a
closure colostomy at
Songklanagarind Hospital in Hadyai,
Thailand.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Exclusion criteria
-
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Data collection

• prior operation
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Study Design : Material and
Method
Statistical study
- Data collected and calculated by
manual input with Microsoft Excel
2007 ®
- Numerical data were compared with
Student ‘s t-test CI 95%
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t

Result
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Resul
t
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Factor
detail
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Factor detail : Ganglion
cell
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis :
Adhesion
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis : Bowel
preparation
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis : Fecal
contamination
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis : Co-
morbidity
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis :
Ganglion cell
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Result : Influencing factor analysis :
Colostomy type
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Discussio
•   n
• Colostomy still was a necessary
operation that helped ARM patient
for defecation ,waiting for total
correction.

• Complication of colostomy closure

have had a little collected and
described.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Discussio
•   n
• Some factors had impact of their
outcome such as colostomy type, co-
morbidity prior surgery and adhesion
during surgery.

• And some suspected factors was

proven that (Intra-operative fecal
contamination ,bowel preparation
quality ,ganglion cell number )their
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Discussio
•   n
• Nevertheless, our detail were too
little too decided some factor was
influencing or not furthermore long
term complication and other
outcome were needed more study.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Limitatio
•   n

• Some factors (Fecal contamination and

bowel preparation quality ) had too little
data too calculated for significance
relationship.

• Some outcome and complication may be

reflect that impact of both colostomy
closure and surgical correction,eg. PSARP
, anoplasty, such as fecal impactation
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Limitatio
•   n

• Even through each surgeon in

thisinstitute used same protocol and
practical method to take care their
patient ,many aspect still be different
such as surgical skill , decision to start
feeding and decision to discharge patient
are upon their experience.
 Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Conclusio
n
• The factors that had impact of
closure colostomy outcome included
colostomy type, co-morbidity prior
surgery, and adhesion during
surgery.

• But the intra-operative fecal

contamination, bowel preparation
quality, and ganglion cell number
Outcome of Colostomy Closure and Influencing
Factors
in patients with ARM.
Thank you for your
attension